The development of Military Psychiatry / Military Psychology in Sri Lankan Armed Forces

 

Dr Ruwan M Jayatunge, M.D. PhD 

Overview

A discussion of military psychiatry in Sri Lanka should be grounded in the history of its armed forces and the conflicts they faced. With a recorded history spanning more than 2,500 years, the island endured repeated invasions from India, which its people resisted with considerable courage. Portuguese forces invaded in the sixteenth century, but Sri Lankan resistance thwarted their efforts to establish control; the Dutch, too, failed to subjugate the island. British forces arrived in the eighteenth century and suffered a major defeat in 1803, although political upheaval and the actions of Kandyan chieftains led to the kingdom’s cession to British rule in 1815.

 

Under colonial administration, the Ceylon Defence Force was established, and Sri Lankan troops served alongside British forces in both World Wars. After independence, Sri Lanka formed the Sri Lanka Army in 1949. It later faced the 1971 insurrection and the Eelam War, which required full mobilization from 1983 to 2009.

 

The war produced extensive psychological casualties, yet conditions such as post-traumatic stress disorder went unrecognized for many years. Although the conflict ended in 2009, combat-related trauma persisted, affecting both former service members and society more broadly. The reverberations of war continue to be felt in Sri Lanka.

 

  

The Ceylon Defence Force

 

Established by legislative ordinance in 1910, the Ceylon Defence Force (CDF) served as the main military organization during World War I (1914–1918). At that time, Sri Lanka, known as Ceylon, did not possess an independent national army; rather, it functioned as a colonial defense force under British Army command.

 

The CDF was primarily a reserve volunteer unit, predominantly led by British officers, while the enlisted soldiers were Ceylonese. With the onset of World War, I in 1914, the CDF was fully mobilized to safeguard the island, focusing on local defense tasks such as securing vulnerable locations around Colombo harbor.

 

Despite its primary role being island defense, many Sri Lankans volunteered to serve on various global fronts. As a British crown colony, Ceylon's citizens were integrated into the British Imperial forces, contributing significantly to multiple theaters of war. Notably, during the Gallipoli Campaign in 1915, the Ceylon Planters' Rifle Corps, composed of volunteer planters from the hill country, was deployed to Egypt and attached to the Australian and New Zealand Army Corps (ANZAC), where they distinguished themselves, including serving as the administrative bodyguard for ANZAC commander Lt. Gen. William Birdwood. Additionally, the Ceylon Sanitary Corps, a specialized medical and logistical unit, was dispatched to Mesopotamia in 1917 to provide essential medical relief and sanitation support to British and Indian forces in challenging desert conditions.

 

Ceylonese soldiers who served on the European frontlines encountered the same devastating industrial artillery bombardments, gas attacks, and grim trench conditions that severely impacted the mental well-being of their Western counterparts. Indigenous Sinhalese troops actively engaged in World War I, with many experiencing shell shock, a condition documented in their medical records due to their enlistment in regular British units. A notable case is Reginald Hermon, a soldier of mixed English and Kandyan Sinhalese descent, who joined the prestigious Coldstream Guards at the age of 18. Military documentation reveals that Hermon suffered from severe shell shock on February 28, 1918, while on the Western Front. Despite enduring psychological trauma, he returned to combat, sustained injuries, and was awarded the Military Medal for his bravery before being demobilized. Ultimately, 442 Ceylonese servicemen lost their lives during World War I.

 

World War 2

 

During World War II (1939–1945), Ceylon, now Sri Lanka, had no independent national army. Its defense was handled by the Ceylon Defence Force (CDF), a colonial volunteer force under British command. After Japan entered the war and Singapore fell in 1942, Ceylon became a key Allied headquarters in South Asia, hosting Admiral Lord Louis Mountbatten’s South East Asia Command in Kandy.

 

The CDF expanded from a small peacetime militia to a peak of 14,892 personnel in 1945, including 645 officers and 14,247 other ranks. More than 4,000 are estimated to have served overseas, providing combat, support, or garrison services in locations including the Middle East, the Cocos Islands, Burma, and Malaya. 

 

No definitive figures record how many Ceylonese soldiers experienced shell shock or other psychological trauma during the war. Such cases were often underreported and poorly documented by British military authorities, leaving historians and researchers to rely on indirect evidence. Historical accounts suggest that some Sri Lankan veterans suffered from shell shock, and novelist W. A. Silva’s short stories portrayed the distress and psychological struggles of soldiers returning from the conflict.  During World War II, British and Ceylonese military medical boards concentrated primarily on physical injuries. Psychological distress was stigmatized, dismissed as malingering, or classified under broad labels such as anxiety neurosis, leaving many cases of wartime trauma undocumented.

 

 

Easter Sunday Raid on Colombo

 

On Easter Sunday, April 5, 1942, a Japanese force of more than 125 aircraft, led by Commander Mitsuo Fuchida, who had also commanded the attack on Pearl Harbor, struck Colombo. Its main targets were British warships, the harbor, and air bases. Although the British fleet had largely been warned and dispersed, the attack caused serious damage, sank several vessels, and hit civilian areas. Local defenders, including members of the Ceylon Garrison Artillery and Ceylon Defence Force, operated anti-aircraft guns under intense fire. Veterans later recalled that many inexperienced volunteers suffered panic and profound distress amid the thunder of the guns, burning ships, and bodies in the harbor. Although combat-related psychological trauma was experienced during the Second World War, its formal study and recognition in Sri Lanka came only decades later.

  

 

The Formation of the Sri Lanka Army

 

Sri Lanka gained independence from British rule in 1948, leading to the establishment of its military as the Ceylon Army under the Army Act No. 17 of 1949. Initially, this force was quite small and primarily ceremonial, comprising only a handful of officers and essential personnel. In its early days, the Ceylon Army did not engage in active combat but served mainly in administrative and ceremonial capacities. The formation included just two minor combat units: The Ceylon Infantry Regiment, which later became known as the Ceylon Light Infantry, and the 1st Heavy Anti-Aircraft/Coast Artillery Regiment. Brigadier Roderick Sinclair, the Earl of Caithness, was appointed as the first commander of the Ceylon Army. By its official commencement on October 10, 1949, the army had fewer than 50 active regular soldiers, with the total number of regular officers being under 20.

 

The Sri Lanka Army Medical Corps

 

The Sri Lanka Army Medical Corps traces its origins to 29 July 1881, when a stretcher-bearer company was established within the Ceylon Light Infantry Volunteers. It later became an independent volunteer unit, the Ceylon Medical Corps, in 1911. In October 1950, it was formed as a regular unit of the Ceylon Army under the command of Major H. C. Serasinghe. During both World Wars, military medical services focused on evacuating casualties, treating injuries and illness, and preventing disease.

 

In World War II, the Ceylon Medical Corps served under the Ceylon Defence Force, providing medical support, casualty care, and garrison healthcare. It had no independent psychiatric units or protocols for treating shell shock or war trauma; instead, it operated within British military medical systems. British Army psychiatrists directed treatment, while Ceylonese medical officers, orderlies, and nursing staff provided daily care, medication support, and rehabilitation, including for cases described in World War II as battle exhaustion.

 

 

The 1953 Hartal

 

The 1953 Hartal was the army’s first major internal deployment. On August 12, a nationwide strike and protest erupted after the government abolished the rice subsidy, sharply increasing the price of this staple. Organized by left-wing parties, the protests disrupted the country and escalated into riots, railway sabotage, and clashes with authorities. The government declared a state of emergency and deployed the small, largely ceremonial army alongside the police to restore order. Troops guarded key infrastructure, enforced curfews, and cleared roadblocks under hostile conditions. As police struggled to contain the unrest, soldiers used lethal force; at least ten civilians were killed, while hundreds were injured or arrested. Amid the upheaval, Prime Minister Dudley Senanayake and his cabinet temporarily sought refuge aboard the British warship HMS Newfoundland in Colombo Harbor. In 1953, the Ceylon Army had no established framework for military mental health, psychological counselling, or operational stress management, despite the severe psychological toll on its soldiers.

 

 

1958 Ethnic Riots

 

The 1958 Anti-Tamil Ethnic Riots were the first major island-wide communal conflict in independent Sri Lanka. Fueled by tensions over the Sinhala Only policy, the violence from May 22 to 29 left hundreds dead and caused widespread arson, looting, and the displacement of more than 25,000 Tamil civilians. For the relatively young Ceylon Army, traditionally a small peacetime force, the crisis prompted an unprecedented mobilization.

 

On May 27, Governor-General Sir Oliver Goonetilleke declared a state of emergency and placed the military in effective operational control. Under emergency regulations, troops imposed curfews, made mass arrests, dispersed armed crowds, and were authorized to shoot looters, arsonists, and curfew violators.

 

The 1958 riots involved horrific acts of public violence. The military was neither structured nor psychologically prepared for urban pacification; the crisis took an immense mental and emotional toll on the deployed personnel. The military operated under a strict culture of stoicism. Soldiers who experienced psychological breakdowns, severe anxiety, or insomnia after suppressing the riots had no access to mental health support.

 

 

The 1971 JVP Insurrection

 

On April 5, 1971, the Marxist group known as Janatha Vimukthi Peramuna (JVP), consisting mainly of radicalized, educated rural youth, launched a coordinated armed uprising across Sri Lanka, attacking police stations to seize weapons and overthrow the government. The insurrection confronted the Ceylon Army with an unprecedented crisis: it had only about 6,700 regular personnel and was poorly equipped, with limited automatic weapons, communications, and armoured vehicles. The army moved to protect Colombo and key bases, secure airfields and communication routes, and relieve besieged police stations. The government then mobilized volunteers, recalled retired personnel, and acquired weapons, helicopters, and ammunition from foreign partners, including the UK, the USSR, India, and Pakistan. With reinforcements in place, the army conducted counter-insurgency operations in JVP strongholds. By June, the uprising had been suppressed, and more than 10,000 suspected insurgents had been arrested.

 

The conflict was brief but bloody. Official records and government estimates indicate that approximately 30 to 45 Ceylon Army personnel were killed in ambushes and attacks on police stations, while more than 100 were wounded. Across the Army, Police, Navy, and Air Force, state forces lost an estimated 60 to 70 personnel. JVP insurgent and civilian casualties were far higher, with estimates ranging from 1,200 to more than 5,000 during the fighting and subsequent crackdown.

The 1971 Insurrection also marked a profound turning point in the psychological well-being of military personnel, exposing them to a disturbing form of asymmetric warfare. Unlike soldiers in conventional conflicts against foreign forces, they faced a concealed enemy within their own communities. Many insurgents were young Sinhala-Buddhist men and women from rural backgrounds similar to those of the soldiers, making the violence a source of moral injury and deep psychological conflict.  After the rebellion was suppressed, soldiers assigned to guard and interrogate thousands of detained youths faced further psychological strain, with exposure to harsh interrogation practices contributing to lasting anxiety and guilt.

 

In 1971, the Sri Lanka Army lacked appropriate psychological services for affected personnel. Some soldiers and police officers traumatized by the uprising attempted to cope through self-medication or alcohol, and some officers died prematurely from alcohol-related illnesses

 

The 1987–1989 Insurrection

The 1987–1989 insurrection was a fratricidal conflict that profoundly reshaped the country’s institutions and the combatants’ experience of war. After India deployed its Peacekeeping Force to the North and East, the state redirected its battle-hardened forces to the Sinhala-majority South to confront a nationalist Marxist guerrilla uprising. Fought within shared ethnic, linguistic, and regional communities, the conflict imposed an immense psychological toll on security personnel, undermined conventional rules of engagement, and left lasting generational scars.

The JVP’s military wing intensified this pressure by targeting the families of soldiers and police officers. In 1989, it threatened to execute the parents, spouses, and children of personnel who refused to abandon their posts. This strategy made professional detachment nearly impossible: serving the state meant exposing loved ones to danger, trapping security personnel in fear, guilt, and desperation. As concern for personal and familial survival overwhelmed institutional restraint, the counter-insurgency became an intimate and brutal struggle among neighbors and compatriots.

Many soldiers later returned to the conventional war in the North and East carrying unaddressed trauma from violence they had witnessed and committed in the South. The normalization of extrajudicial violence and the persistence of impunity hardened the armed forces’ outlook, leaving psychological and institutional damage that shaped Sri Lanka and its defenders for decades.

The July 1983 Ethnic Riots

The July 1983 ethnic riots marked a catastrophic turning point, escalating Sri Lanka’s low-level insurgency into full-scale civil war. Although accounts often focus on the pogroms’ devastating civilian toll, the crisis also placed the young Sri Lankan military under extraordinary tactical, operational, and ethical strain. The armed forces had no formal military psychiatry, counseling, or psychological support services, leaving personnel to confront trauma, moral conflict, and institutional breakdown alone. The immediate trigger came on the night of July 23, when an LTTE ambush struck a patrol codenamed Four Four Bravo in Thirunelveli, Jaffna. The patrol, drawn from the 1st Battalion of the Sri Lanka Light Infantry, was hit by a roadside mine and then subjected to heavy automatic gunfire. Thirteen soldiers, including patrol commander Lieutenant Vass Gunawardena, were killed. The attack’s horrific violence deeply affected the military community, and the bodies’ return to Colombo for a mass funeral helped ignite long-standing ethnic tensions across the island.

As anti-Tamil violence spread rapidly through major cities, the military was thrust into a volatile domestic crisis. Still grieving comrades killed in recent attacks, soldiers were sent to enforce curfews, control mobs, and protect tens of thousands of Tamil civilians fleeing burning neighborhoods. The Sri Lanka Navy also mounted a dangerous evacuation, turning vessels into emergency transports and carrying refugees from Colombo and Trincomalee to the Jaffna peninsula, away from threats on the mainland.

The psychological toll on troops was severe. Grief and combat stress were compounded by the conflict between their fight against Tamil separatists in the North and their duty to protect Tamil civilians from Sinhala rioters in the South. With no counseling, debriefings, or trauma care, soldiers were expected to endure their distress in silence. Many carried emotional exhaustion and moral injury back to the front lines, leaving hidden scars that would later contribute to the development of modern military psychiatry in Sri Lanka.

 

The Eelam War 1983- 2009

 

The Sri Lankan Civil War, known historically across its phases as the Eelam War, stands as one of the most prolonged, intense, and destructive asymmetric conflicts of the modern era. Spanning nearly twenty-six years from 1983 to 2009, the war pitted the state apparatus against the Liberation Tigers of Tamil Eelam, a separatist militant organization that pioneered advanced guerrilla tactics, suicide bombings, and conventional-style artillery warfare.

 

For the Sri Lanka Army, this conflict transformed a small, ceremonial post-colonial internal security force into a massive, highly conventional, and battle-hardened military machine. Beneath the tactical maneuvers and geopolitical shifts lies a story of staggering human cost, marked by massive troop deployments, high-casualty campaigns, and a profound, delayed awakening to the psychological devastation of war trauma on the individual soldier.

When full-scale hostilities erupted following the Black July riots of 1983, the Sri Lanka Army was fundamentally unequipped for a major insurgency, numbering fewer than fifteen thousand regular personnel. As the conflict intensified across four distinct phases, the state embarked on an unprecedented scale of military expansion. During Eelam War I, from 1983 to 1987, characterized by small-scale guerrilla ambushes and early conventional responses, the army grew to roughly thirty thousand troops.

 

Eelam War II, lasting from 1990 to 1995, resumed with severe conventionality following the withdrawal of the Indian Peace Keeping Force, pushing army numbers past seventy thousand to defend isolated garrisons in the North and East. By Eelam War III, between 1995 and 2002, heavy conventional warfare featuring large divisional movements, artillery duels, and amphibious landings forced the army's strength to surpass one hundred thousand personnel. Finally, during the multi-front offensive of Eelam War IV from 2006 to 2009, the Sri Lanka Army reached a peak active-duty deployment of approximately one hundred and fifty thousand to one hundred and eighty thousand personnel to permanently crush the militant leadership and hold secured territory.

To execute this massive campaign, the army launched dozens of named operations throughout the war, each carrying an immense human cost. In 1987, the military executed Operation Liberation, also known as the Vadamarachchi Operation, which was the army's first major brigade-sized conventional victory aimed at reclaiming the Jaffna Peninsula from early militant control, though it was halted prematurely by Indian diplomatic intervention. In 1995, Operation Riviresa, or Sunray, successfully restored state control over Jaffna City through a highly intense urban assault. This was followed by Operation Jayasikurui, meaning Certain Victory, between 1997 and 1999, which aimed to open a main land supply route through the militant-controlled Vanni jungle and became the longest, most gruelling campaign of attrition in Sri Lankan military history. The conflict ultimately culminated in the Final Offensive from 2006 to 2009, a relentless multi-divisional push that concluded in May 2009 with the total military defeat of the militant leadership at Mullaitivu.

The conventional and asymmetric nature of these campaigns extracted a devastating physical toll on state forces. Personnel routinely faced heavy artillery, mortar barrages, improvised explosive devices, landmines, and wave-style suicide assaults. Over the twenty-six-year conflict, more than twenty-three thousand Sri Lanka Army personnel were killed in action or went missing. Furthermore, upwards of sixty thousand to seventy thousand soldiers were wounded in action, with thousands suffering permanent disabilities, including amputations caused by the widespread deployment of pressure-plate anti-personnel mines. The final phase of the war alone accounted for a highly compressed and intense portion of these numbers, with over five thousand security forces losing their lives in the final three years of relentless fighting.

For the vast majority of the civil war, the psychological toll on soldiers was shrouded in stigma, institutional denial, and an absolute lack of specialized care. While physical wounds were treated with urgency by the Sri Lanka Army Medical Corps, mental breakdowns were frequently misdiagnosed as malingering, cowardice, or general weakness. During Eelam Wars II and III, military doctors stationed in the northern war zones began noticing a recurring pattern among frontline infantrymen.

 

Soldiers exposed to relentless artillery bombardments, the sudden loss of comrades, and prolonged isolation in besieged camps like Elephant Pass or Pooneryn exhibited severe psychological breakdowns. Characterized by dissociative reactions, acute stress reactions and sudden aggression, local clinicians colloquially termed this manifestation Palaly Syndrome, named after the main military base and hospital hub in the Jaffna Peninsula. It was Sri Lanka’s raw, unrecognized equivalent of World War I’s shell shock and World War II’s battle exhaustion.

Sri Lanka Army soldiers operated under conditions that engineered severe psychiatric distress. The constant threat of buried mines and sudden ambushes meant that even behind frontline trenches, a soldier's nervous system was never at rest, resulting in unremitting hyper-vigilance. Urban fighting, handling displaced civilian populations, and witnessing the horrific aftermath of civilian-targeted suicide bombings in the south created deep, internal ethical conflicts and moral injury.

 

Additionally, unlike foreign militaries deployed on distinct overseas tours, Sri Lankan soldiers fought within their own country. A soldier could be in a bloody firefight in the morning and, via a short train or bus ride on leave, find themselves in a peaceful civilian environment forty-eight hours later. This jarring contrast severely disrupted the psychological transition required to process combat trauma.

For nearly two decades, the army operated without a single dedicated military psychiatrist, meaning traumatized personnel were quietly discharged or returned to the front lines with basic sedatives. This systemic failure reached a breaking point by the early 2000s, as rising rates of desertion, domestic violence, and veteran suicides forced an institutional reckoning.

 

In March 2002, the Sri Lanka Army officially established its first Psychological Treatment Center and Psychiatric Unit at the Colombo Military Hospital. This milestone finally institutionalized the diagnosis of Post-Traumatic Stress Disorder within the ranks, introducing modern psychotherapies like Cognitive Behavioural Therapy and Eye Movement Desensitization and Reprocessing. In 2005, the army granted its first official medical discharge solely on the grounds of combat-induced PTSD.

The Eelam War forged the modern Sri Lanka Army at an immense cost. While the military achievements of the campaign are studied for their tactical significance, the legacy of the conflict is indelibly stamped on the minds of those who survived it. The transition from treating Palaly Syndrome as a disciplinary issue to recognizing PTSD as a legitimate wound of war remains one of the most critical, albeit delayed, victories in the history of the Sri Lanka Army Medical Corps.

 

 

The Institutional Denial of PTSD in the Early Sri Lankan Military

 

Initially, Sri Lankan military forces rejected PTSD as an “American illness,” and an unofficial taboo discouraged soldiers from discussing or reporting psychological distress. Although military surgeons and physicians treated physical combat injuries, psychological trauma received little attention. In the war’s early years, the military lacked a structured system for evaluating mental health, managing trauma, or supporting troops returning from the front lines. This neglect was associated with increased suicides in bunkers, aggression toward civilians, domestic and child abuse, declining productivity, and rising disciplinary problems. Combat fatigue and other behavioral changes were often treated as misconduct or desertion rather than signs of clinical trauma.

 

 

Initiating Psychiatric and Psychological Services 

 

Recognizing the psychological consequences of the Eelam War, some forward-thinking military officers advocated for the introduction of psychiatric services within the Sri Lankan military. Nevertheless, until the later stages of the conflict in 2007, the Sri Lanka Army had no full-time psychiatrist. Instead, a visiting psychiatrist attended the Military Hospital in Colombo once a week to assess and treat affected soldiers. Commonly identified conditions included war-related trauma, depression, acute stress reactions, dissociative reactions, and post-traumatic stress disorder (PTSD). In 2002, psychological counselling and psychotherapy services were established at the hospital, enabling affected personnel to receive medication and therapeutic support, including cognitive behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), dialectical behaviour therapy (DBT), and mindfulness-based interventions.

 

 

PTSD in the Sri Lanka Army

 

Post-Traumatic Stress Disorder within the Sri Lanka Army is a deeply complex clinical and institutional issue, shaped by nearly 30 years of relentless asymmetric warfare during the Eelam War. The trajectory of how the military understood, identified, and treated PTSD mirrors a broader transition from institutional denial and heavy social stigma to structural medical recognition.

 

For the first two decades of the civil war, the term PTSD was virtually non-existent in the Sri Lankan military lexicon. Instead, frontline medical officers dealing with acute psychological trauma in the northern war zones observed a cluster of sudden, severe psychiatric breakdowns. Infantrymen exposed to relentless artillery barrages, multi-day sieges, and heavy casualties frequently exhibited symptoms like confusion, severe tremors, hysterical blindness, avoidance and unprovoked aggression. Because many of these casualties were processed through the primary military base and medical airfield in the northern peninsula, local clinics were not equipped to handle these affected soldiers.  Often they were treated with sedatives.

 

It was the Sri Lankan military's raw, unrecognized equivalent of World War I’s shell shock. Without dedicated military psychiatrists or formalized diagnostic criteria, the army routinely treated these cases as temporary operational exhaustion, malingering, or a lack of personal discipline. Soldiers were often given basic sedatives, granted brief rest periods, and promptly sent back to the front lines.

The nature of the civil war generated distinct psychological stressors that altered how PTSD manifested in Sri Lankan soldiers compared to Western militaries. One of the most significant compounding factors was the absolute absence of a psychological buffer. Unlike Western soldiers who deployed on distinct overseas tours and returned to a completely separate home country, Sri Lankan soldiers fought a war within their own borders. A soldier could survive a catastrophic ambush in the northern jungles and be sitting in a peaceful civilian village on leave just forty-eight hours later. This jarring, rapid alternation between high-intensity combat and normal civilian life severely disrupted the mind's ability to naturally process trauma.

 

Furthermore, the pervasive threat of pressure-plate anti-personnel landmines, such as the locally feared Jonny mine, meant that soldiers could never truly drop their guard. Even in rear assembly areas, the constant anticipation of a sudden, catastrophic blast kept the autonomic nervous system in a permanent state of high alert, engineering unremitting hyper-vigilance.

 

Additionally, the war was fought against a domestic insurgent force. Soldiers often engaged in close-quarters urban combat, managed massive influxes of displaced civilians, and witnessed the immediate aftermath of devastating civilian-targeted suicide bombings. The close cultural and geographical proximity to the destruction created deep internal ethical conflicts and profound moral injury.

By the late 1990s and early 2000s, the systemic neglect of combat-induced psychological trauma began to fracture the army's internal stability. The military faced a massive crisis characterized by high rates of desertion, spikes in alcohol abuse within the barracks, domestic violence in rural garrison towns, and a rising rate of suicide among veterans. Recognizing that the physical survival of the army depended on addressing its mental health crisis, the military shifted its approach.

 

Between March 2002 and December 2006, a visiting consultant psychiatrist evaluated 824 Sri Lankan Army personnel referred to the psychiatric unit at Colombo’s military hospital. Structured interviews and a DSM-IV-based PTSD checklist assessed combat exposure, personal circumstances, and current mental health. Fifty-six personnel met the full criteria for PTSD and six had partial PTSD, yielding a reported PTSD rate of 6.7%. Greater combat exposure was associated with service in the northern and eastern regions, where many personnel reported symptoms of major depression, generalized anxiety, or PTSD. Other diagnoses included adjustment disorder in 135 soldiers (16.38%), depressive disorder in 129 (15.65%), dissociative disorder in 89 (10.8%), other psychiatric conditions—including schizophrenia, bipolar disorder, and acute transient psychotic disorder—in 78 (9.46%), somatoform disorder in 65 (7.88%), traumatic brain injury in 27 (3.27%), and alcohol- or substance-related disorders in 29 (3.51%).

 

Among those with full PTSD, 45 had served in operational areas for more than three years, 15 had sustained grievous injuries, 22 had been injured less severely, 49 had witnessed killings, 17 had previously attempted suicide, and 30 had experienced childhood trauma. Research indicates that active combat can contribute substantially to PTSD and other stress-related disorders. Life-threatening events may overwhelm coping capacities and affect mental health both during service and for years afterward. Symptoms such as flashbacks, severe anxiety, and emotional numbness can impair daily functioning, highlighting the importance of examining how combat exposure affects psychological well-being.

 

A significant milestone in the recognition of psychological injuries occurred in 2005, when the Sri Lanka Army issued its first official medical discharge with full benefits to a prisoner of war whose primary diagnosis was combat-induced post-traumatic stress disorder. This decision affirmed that mental trauma could be recognized as a legitimate war-related injury.

 

 

Post-War Challenges

 

Although the Eelam War ended in 2009, its psychological consequences persist. Sri Lankan military personnel continue to face complex psychological, physical, and socioeconomic challenges, with many combat veterans experiencing post-traumatic stress disorder, depression, and anxiety. Some suffer in silence, while others remain undiagnosed or untreated; for many, symptoms emerge only years later, often during the transition from a highly structured, hyper-vigilant military environment to civilian life.

 

Nearly 400 soldiers reportedly died by suicide between 2009 and 2012, underscoring the scale of post-war distress and the lack of timely psychological support. Reports of former service members engaging in crime or social violence represent only the visible surface of a much broader, largely hidden problem. 

 

The transition from military service to civilian life remains inadequate, leaving many soldiers vulnerable to post-war adjustment difficulties. The military has not sufficiently addressed the related psychosocial challenges.

 

Clinical evaluations by the Sri Lanka Army indicate that PTSD can disrupt family life and contribute to domestic strain, marital difficulties, and social isolation. The effects may also extend to the next generation: research published in Psychological Services reports elevated rates of psychiatric conditions among children and adolescents of deceased service members. Some veterans also turn to alcohol or other substances to cope with traumatic memories. Many former soldiers face significant physical disabilities, including amputations and blast injuries.

 

The Army has reportedly cared for an estimated 6,000 post-war amputees. Severe injuries, chronic pain, and traumatic brain injuries can require lifelong medical care, prosthetic maintenance, and specialized rehabilitation. After retirement, many lower-ranking personnel also struggle to adapt their combat experience to civilian employment, contributing to identity challenges and economic insecurity. 

 

Financial hardship has left some soldiers vulnerable to criminal exploitation, with reports of veterans joining gangs and participating in armed robberies. Others have reportedly served as mercenaries in the Russia–Ukraine war. In recent years, Sri Lanka’s economic pressures have also undermined many veterans’ income, life satisfaction, and financial security. Historically, inadequate civilian reintegration programs and limited legal employment options left some traumatized or deserted veterans susceptible to recruitment by criminal networks. Meanwhile, active-duty personnel have taken on peacetime responsibilities, including humanitarian demining, infrastructure projects, and disaster and public-health response. Their continued exposure to high-stress situations may increase the risk of trauma-related difficulties.

 

Addressing Post-War Issues

Sri Lanka’s collective experience of conflict has left many military personnel facing complex and often untreated conditions, including complex post-traumatic stress disorder (C-PTSD), PTSD, depression, dissociative and somatoform symptoms, substance-use disorders, and other health problems. Many do not receive timely, appropriate, or sustained care, while some experience delayed combat-stress reactions only after retirement, when their symptoms may remain unrecognized and untreated.

Difficulties adjusting to civilian life have also contributed to serious social consequences: some former combatants become involved in criminal activity, while others have travelled to work as mercenaries in the Russian-Ukrainian war. Responding to these interconnected psychological, social, and structural challenges requires a coordinated, island-wide system of expert support and comprehensive, phased reform.

Mental health care should become a routine part of military service and veterans’ support, with regular screening, veteran-led peer networks, and integrated treatment for trauma and substance-use disorders. Rather than relying on abrupt discharge, the transition to civilian life should be prepared through training in civilian employment skills, financial literacy, and psychological adjustment.

A national veterans’ transition agency could coordinate employment, medical care, and mental health services after discharge, while partnerships with private-sector employers could help translate military experience into recognized civilian qualifications. Dedicated job-placement programs and access to microfinance could further support veterans seeking employment or establishing businesses. These services should be available throughout the country, delivered by trained professionals, and strengthened through effective monitoring to ensure that veterans receive consistent, appropriate care.

Special Thanks to 

Dr. Neil J Fernando - The former Visiting Psychiatrist, Sri Lanka Army 

Dr. D.P.D. Wijesinghe - The former Visiting Psychiatrist, Sri Lanka Army